The tricuspid valve annulus: study of size and motion in normal subjects and in patients with tricuspid regurgitation.

Abstract

SUMMARY The tricuspid valve leaflets and their annular attachments were recorded by two-dimensional echocardiography from a view of the right ventricular inflow tract obtained by placing the transducer at an intermediate position between the left ventricular apex and the left lower sternal border. The transducer was rotated, and recordings were made at 300 rotational intervals around the circumference of the tricuspid valve annulus. The cyclical pattern of variations in tricuspid annular size was studied with 12 measurements made during the cardiac cycle in five normal subjects. Annular areas and circumferences were measured. The overall motion pattern was-similar to that reported in normal mitral valve annular study. Subsequently, in 16 normal subjects and 18 patients with tricuspid regurgitation, the maximum and minimum tricuspid annular sizes and their percent reduction were measured. The mean maximum annular circumference and area were 11.9 ± 0.9 cm (mean ± SD) and 11.3 ± 1.8 cm2 in normal subjects. They were significantly greater in tricuspid regurgitation (14.0 ± 0.7 cm and 15.8 ± 1.8 cm2, respectively). The mean minimum annular sizes were much larger in tricuspid regurgitation (12.5 ± 0.6 cm and 13.0 ± 1.4 cm2) than in normal subjects (9.6 ± 0.9 cm, 7.6 ± 1.4 cm2). Thus, the percent reduction of annular circumference and area were significantly decreased in tricuspid regurgitation. For anatomic correlations, measurements of the tricuspid annular circumference were made at autopsy in 18 hearts without underlying valvular disease. The annular circumference was measured in the fresh and fixed states. The measurement in the fresh state was 13.5 ± 0.8 cm and in the fixed state was 12.0 ± 0.8 cm. The values measured in the fixed hearts were more similar to measurements obtained by echocardiography in a group of normal subjects.Thus, tricuspid annular reconstruction by the new two-dimensional echocardiographic method provides additional information about normal and abnormal size and function of the tricuspid valve annulus.THE MOST COMMON cause of tricuspid regurgitation (TR) is not intrinsic involvement of the valve itself, but dilatation of the tricuspid valve annulus.' The results of tricuspid annuloplasty for correction of significant tricuspid regurgitation have usually been successful.2-6 No technique is available to measure tricuspid annular size and assess annular function, and no reports have described the tricuspid annular size and motion in intact man. In a study using two-dimensional echocardiography from our laboratory, we described a method of reconstructing the mitral annulus using multiple apical planes obtained by 30°rotations of the transducer.7 In the present report, we used a similar method to reconstruct the tricuspid annulus using multiple echocardiographic planes obtained from another transducer location.In the present paper we describe a noninvasive method of evaluating the size of the tricuspid valve annulus and its variations during the cardiac cycle in

Tricuspid Valve Surgery Based on the Mechanisms of Functional Tricuspid Regurgitation

“…In a detailed two-dimensional echocardiographic study by Tei et al, the dynamic, geometric changes of the TA during the cardiac cycle have been demonstrated. 8) They were 19% of the circumference and 33% of the cross-sectional area in normal human subjects, and 10% and 18% in patients with fTR.…”

Cardiac imaging in valvular heart disease

“…Pathological tricuspid regurgitation (TR) is usually functional owing to annular dilatation, which may arise because of LV failure, RV pressure and/or volume overload, or chamber dilatation. The tricuspid valve (TV) annulus is very dynamic and changes markedly with different loading conditions; even during the normal cardiac cycle, there is a 30% reduction in annular area in atrial systole [56]. This means that the degree of TR is very variable and heavily dependent on intravascular volume status, RV loading and RV function.…”

Anaesthesia for transvenous transcatheter tricuspid valve-in-valve implantation

“…The normal valve area is 7.6 ± 1.4 cm. 2,4 Anatomically, the tricuspid valve is closely related to the coronary sinus, atrioventricular nodal conduction tissue and the right coronary artery.…”